Anticoagulant Therapy in the Prevention and Treatment of Ischemic Stroke

Anticoagulant therapy plays an important role in thromboembolic disorders, in primary and secondary prevention as well as treatment, and especially in the prevention of brain systemic embolism in patients with non-valvular atrial fibrillation and other sources of cardioembolic strokes. Unless contraindicated, warfarin is recommended for the treatment of these patients. Warfarin significantly reduces the risks of stroke and death, but increases that of haemorrhage. Life-threatening intracerebral haemorrhage is the most serious complication of oral anticoagulant therapy, with a mortality that can exceed 50%. The need for frequent laboratory monitoring, a narrow therapeutic window, and a plethora of interactions with food and drugs are also reasons to seek new, safe, effective anticoagulant agents that are convenient to use. New oral direct thrombin inhibitors and factor Xa inhibitors present promising alternatives to warfarin. Unfractionated heparin or low-molecular-weight heparins are not recommended for the prevention of early stroke recurrence in patients with acute ischemic stroke of cardioembolic origin. Low-close unfractionated subcutaneous heparin or low-molecular-weight heparins should be considered for patients with acute ischemic stroke at high risk of deep venous thrombosis or pulmonary embolism.